PEPTIDE INTEREST SURVEY

1

Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

AGE

5

SEX

MALE

FEMALE

6

HEIGHT

7

CURRENT BODYWEIGHT

8

ESTIMATED BODY FAT % (IF KNOWN)

10

HAVE YOU USED PEPTIDES BEFORE?

NO, NEVER

YES, CURRENTLY USING

YES, USED IN THE PAST

11

IF YES, WHICH PEPTIDES HAVE YOU USED?

12

HOW MANY DAYS PER WEEK DO YOU TRAIN?

0-1

2-3

4-5

6-7

14

ARE YOU CURRENTLY ON TRT/HRT?

YESNO

15

ARE YOU CURRENTLY USING INSULIN?

YESNO

16

ARE YOU CURRENTLY TAKING ANY MEDICATIONS?

17

DO YOU HAVE ANY DIAGNOSED MEDICAL CONDITIONS?

18

HOW WOULD YOU RATE YOUR APPETITE?

19

DO YOU STRUGGLE WITH FOOD CRAVINGS OR OVEREATING?

20

ARE YOU COMFORTABLE WITH SUBCUTANEOUS INJECTIONS?

21

ARE YOU READY TO START WITHIN THE NEXT 30 DAYS IF APPROPRIATE?

22

HOW SERIOUS ARE YOU ABOUT IMPROVING YOUR PHYSIQUE AND HEALTH?

23

IS THERE ANYTHING ELSE YOU'D LIKE ME TO KNOW ABOUT YOUR GOALS OR SITUATION?

24

PEPTIDE / RESEARCH COMPOUND ACKNOWLEDGMENT AND ASSUMPTION OF RISK* This field is required. By checking this box and submitting this form, I acknowledge and agree to the following: Research Use Only I understand that the products being discussed or purchased are labeled and supplied strictly for laboratory research, analytical, or educational purposes only. I understand these products are not intended for human consumption, animal consumption, injection, ingestion, topical use, diagnostic use, therapeutic use, cosmetic use, or treatment of any medical condition. Not FDA-Approved for Human Use I understand these products have not been approved by the FDA or any regulatory authority as medications, dietary supplements, cosmetics, or medical treatments. I understand these products are not intended to diagnose, treat, cure, mitigate, or prevent any disease or medical condition. No Medical Advice I understand that no information provided by the seller, website, staff, social media, text message, email, product label, product description, or third-party content is medical advice. I understand that no dosing, reconstitution, injection, cycle, stack, or administration guidance is being provided or authorized. Buyer Qualification I represent that I am at least 21 years old. I agree that these materials will only be used in a lawful research setting and in compliance with all applicable local, state, and federal laws. Prohibited Human or Animal Use I understand that using these products on myself, another person, or any animal is strictly prohibited. I understand that any human, animal, medical, cosmetic, therapeutic, or non-research use is misuse and is outside the seller’s intended purpose. No Warranties I understand these products are provided “as is” and “with all faults” for research purposes only. The seller makes no warranty that the products are safe, effective, sterile, suitable for injection, suitable for human use, suitable for animal use, or appropriate for any specific research outcome. Assumption of Risk I understand that research compounds may carry risks including, but not limited to, contamination, degradation, mislabeling, improper storage, improper handling, unknown biological effects, allergic reactions, injury, illness, disability, or death if misused. I voluntarily assume all risks related to possession, storage, handling, transport, disposal, and any unauthorized use of these products. Medical Conditions and Emergency Care I understand that if I have diabetes, high blood pressure, kidney disease, liver disease, eye disease, diabetic retinopathy, thyroid disease, heart disease, pregnancy, breastfeeding, or any other medical condition, I should seek care from a licensed medical professional. I understand that these products are not a substitute for medical care, prescription medication, lab testing, eye exams, or physician supervision. Release of Liability To the fullest extent permitted by law, I release and hold harmless the seller, its owners, employees, contractors, affiliates, suppliers, and agents from claims, damages, injuries, losses, or liabilities arising from unauthorized use, misuse, improper handling, improper storage, unlawful possession, or use outside the stated research-only purpose. This release does not waive liability that cannot legally be waived under applicable law. Indemnification I agree to indemnify and hold harmless the seller from any claims, damages, penalties, legal fees, or regulatory actions arising from my misuse, unauthorized use, unlawful use, resale, redistribution, or failure to comply with applicable laws. No Reliance I acknowledge that I am not relying on any statement, testimonial, social media post, transformation photo, review, mechanism-of-action discussion, or third-party content as proof of safety, effectiveness, or suitability for human use. Final Acknowledgment By signing or checking this box, I confirm that I have read and understood this acknowledgment, that I agree to be bound by it, and that I understand these products are strictly not for human or animal use.